Munchausen syndrome presenting acutely in the emergency department

Munchausen syndrome is a rare psychiatric disorder in which patients purpos ely harm themselves to gain medical attention. These patients may present t o unsuspecting emergency department (ED) staff members with life-threatenin g signs and symptoms. We report a case of Munchausen syndrome in which a yo ung man with ties to the medical community and a history of substance abuse presented to our ED with refractory hypoglycemia and a dilated right pupil . The patient required large amounts of dextrose, endotracheal intubation, mechanical ventilation, and admission to the intensive care unit. Further i nvestigation revealed that he had purposely injected himself with a large d ose of insulin and instilled atropine drops in his right eye for the purpos e of seeking hospitalization. The history, details, diagnosis, treatment, a nd prognosis are discussed in the context of this case. (C) 2000 Elsevier S cience Inc.